Psychosexual disorders

Psychosexual disorders fall into three main groups in ICD10: sexual dysfunction, gender identity disorders and disorders of sexual preference (Table 1). Sexual dysfunction is the most common of these groups, and so will be discussed in detail.

Table 1 ICD10 classification of sexual disorders

Sexual dysfunction not caused by organic illness or disease Lack or loss of sexual desire Sexual aversion and lack of sexual enjoyment Failure of genital response Orgasmic dysfunction Premature ejaculation Non-organic vaginismus Non-organic dyspareunia Excessive sexual drive

Gender identity disorders Transsexualism. Desire to live and be accepted as a member of the opposite sex Dual-role transvestism. Wearing clothes of the opposite sex in order to temporarily feel like a member of that sex

Disorders of sexual preference Fetishism. Reliance on an inanimate object for sexual arousal Fetishistic transvestism. Wearing clothes of the opposite sex to achieve sexual arousal Exhibitionism. Recurrent exposure of genitals to strangers, usually leading to sexual arousal Voyeurism. Recurrent, secretive observation of people involved in sexual or intimate behaviour such as undressing Paedophilia. Sexual preference for children Sadomasochism. Preference for sexual activity that involves bondage or infliction of pain or humiliation Multiple disorders of sexual preference. Combinations of above disorders

Sexual dysfunction, not caused by organic disorder or disease

The title of this category in ICD10 is misleading. It implies that sexual dysfunction is caused either by organic illness and disease or by psychological factors when, in fact, it is often caused by a combination of the two. An example of this is given in Figure 1 which also demonstrates how sexual dysfunction is often the result of problems in both partners.

Fig. 1 An example of the complexity of some sexual problems.

Clinical assessment

The structure of a sexual history is similar to the history of other presenting complaints. It is important to help the patient describe their problems by asking open questions. Once you have clarified the nature of the problem, it is important to establish how long it has been going on and whether there have been any precipitating or maintaining factors. Sexual problems are often a manifestation of other problems in a relationship and so it is important to find out if there are any such problems. Enquiry should be made about sexual experience and beliefs and it is helpful to know whether the problem has occurred during other relationships. Clinical assessment should involve both partners if possible, as they may have different views about the problem and may both contribute to the problem. Treatment is more likely to be successful if both partners are involved.

A problem often encountered when taking a sexual history is that many people are not used to discussing sexual matters and feel embarrassed about doing so. If the person taking the history appears embarrassed, this will make matters worse. A particular problem is knowing what words to use and feeling comfortable in saying them. For example, terms such as ejaculation and orgasm are stilted and may not be familiar to some people. An alternative term like ‘come’ is more likely to be understood and using colloquial terms like this usually puts people at ease and encourages open discussion. Because of this, it is important to become confident in speaking about sexual matters using terms people understand.

< div class='tao-gold-member'>

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

Mood stabilisers and ECT Old age psychiatry I Diagnosis and classification of schizophrenia Personality disorders – management Antipsychotic drugs Personality disorders – introduction and classification

Stay updated, free articles. Join our Telegram channel

Join

Full access? Get Clinical Tree